Systems integration, secure messaging, interoperability standards, Smart Referral platforms, Provider Directories, Identity management solutions, Electronic Medical Record (EMR) systems – “buzz words” for some, but these cannot be viewed as isolated IT concepts used for administrative convenience. They are foundational pieces that support most health information exchange use cases that drive a better service experience for all. In today’s health system they are working seamlessly together, but maybe just not for every single use case.

Jean-Christophe (JC) Meunier.

When successfully delivered at scale, they combine to meet the expectations of the modern-day patient and clinician, without interrupting the operation (and workflow) of the health system:

information flows seamlessly within, and between, healthcare settings;
patients do not have to retell their story at every point of care;
clinicians can make decisions with better context and with minimal data entry;
health organisations can reduce waste created by duplication, delay and manual rework;
and the information (and its data components) can be further shared and utilised beyond the initial exchange.

FAMILY JOURNEY

Seventeen years ago, my family’s health journey was impacted because of poor information exchange and the duplication of medical records within the hospital system. How did this happen? Why were our referral and registration details manually received and entered separately, forms misplaced, names misspelt, mistyped, etc.? Why were we delivered appointment scheduling complications at the hospital and then confusion with follow-up community management? Why did this event steer us out of the public health system that we had invested in, to be managed in the private health system?

The significance of this event drove me to confront the problem head-on, as Australians have more complex names, medical histories and backgrounds than me.

Having previously worked at SAI Global/Standards Australia, I learnt about the importance of why Australian Standards exist, how they are reviewed, why they evolve, and how they are successfully applied across different industries (eg building and construction, IT, business management, mining and manufacturing). Australian Standards, when referenced in legislation, play a critical role in ensuring a quality assurance uplift when it comes to the trade and function of an industry. Within Health Information Exchange, the Health Level 7 (HL7) standards play a critical role in securing the delivery of information across different software systems and settings. But in healthcare, superseding existing standards is no mean feat.

For example, plumbing, wiring and building codes update regularly (every seven years or so), but the plumbing in your home doesn’t get updated at this rate.

So how do existing standards and systems integration that already work effectively in today’s connected healthcare system get updated and implemented across the healthcare landscape, and who funds this ongoing body of work?

In 2026, healthcare organisations are not mandated to use a software platform or system that supports an approved/compliant secure messaging interface that meets the Australian Standards. Why? The AS4700.2 ORU and AS4700.6 REF standards have been in operation since 2004 and 2005 respectively – they are effective standards and are now over 20 years old.

SYMPTOM – NOT DISEASE

The persistence of fax, post, unsecured email and phone-based chasing in healthcare is not simply a technology failure. It reflects some of the deeper problems that have faced healthcare over many years: information exchange has too often been treated as a local workflow issue rather than a national capability and obsession. As a result, clinical information still moves through fragile channels that aren’t electronically capable, are slow, incomplete, difficult to audit and prone to error – so why not just send a fax?

The recent My Health Record Share by Default reforms do help in reducing the reliance on the fax machine to communicate information within healthcare, but it’s currently only a send-to-a-separate-record-summary process, and not fully enabled using new standards. More investment is required to enable the appropriate use, authentication and access to information when it is needed – like for the Shared Care Plan. It’s not a foolproof solution on its own, as patient information (particularly urgent info which may contain medical opinions) still needs to be shared reliably, and via direct means, with other providers.

TRUST FOUNDATION

Healthcare information is among the most sensitive data a person has. Any system that stores it or moves it around the health system at scale must be built on a framework of privacy, authentication, encryption, auditability and organisational control. Convenience cannot come at the expense of trust. Investments into the framework must be ongoing.

Secure messaging interfaces built to Australian Standards and housed within EMR systems are providing the crucial trust chain for supporting the encrypted transmission of patient information. Defined (authenticated) sender and receiver endpoint identities, tracking dashboards and auditing tools are all supported within the software itself. The safeguards matter not only for operational compliance, but for confidence and convenience in today’s healthcare system. Secure Messaging does this very well, reliably and consistently for both general practices (which communicate with up to 80 different organisations a week) and the larger-scale diagnostic and hospital providers that can communicate with thousands.

eREFERRAL EVOLUTION

Referrals sit at the heart of the care continuum and are acknowledged as one of the most difficult-to-master processes in the health system. They are the handover between primary care, specialists, hospitals, diagnostic providers, community services, allied health and other government and non-government agencies. When referrals are incomplete, manually delivered or poorly structured, the consequences ripple across the wider health and care system: critical data is missing, appointments are delayed, referrals are rejected, clinicians seek additional clarification, data is manually entered, errors are invited into the process and patients are simply left waiting for their required service.

The economic benefits of health information exchange interoperability for Australia (Dr Peter Sprivulis – Australian Health Review 2007) are articulated and understood as productivity benefits:

When information flows automatically and accurately between systems, administrative burden falls.
When referrals are complete the first time, triage improves.
When discharge information reaches general practice promptly, continuity of care improves.
When clinicians can see relevant history, results, medicines and allergies that are relevant to the patient while assessing the symptoms they are dealing with, or the outcomes they are tracking, they can act with greater confidence.

At scale, these gains compound.

A single electronic referral saves minutes; millions of secure exchanges save workforce time, reduce duplication, improve data quality and information integrity, and lower avoidable risk.

Smart eReferrals have already rolled out across most Australian private specialists, public hospitals and health services, and they are much more than just a digital form or PDF. They support systems integration at the referrer and receiver end to ensure information integrity and data pre-population capabilities align with the Australian Standards. Creation must include, wherever possible, the pre-population of referrer details and all relevant patient demographics – including medications, medical, social and family history – with an ability to attach relevant clinical and supporting documentation (tests/investigations, reports, etc). Where possible, they can also draw from the receiver’s clinical systems, or third-party directories, to...

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